Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: People aged ≥16 years with nonspecific low back pain
Intervention: Group exercise program ᵃ
Comparison: Usual care ᵇ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Group biomechanical exercise versus usual care in people with low back pain without sciatica | ||
Quality of life composite scores (SF-36) <4 months: mental or physical component | Favors intervention | Moderate |
Quality of life individual scores (SF-12) <4 months: general health, physical functioning, physical role limitation, bodily pain, social functioning, or health perception | No statistically significant difference | Very Low |
Pain (Visual Analog Scale [VAS]) <4 months | Favors intervention | Very Low |
Function (Oswestry Disability Index [ODI]) <4 months | Favors intervention | Very Low |
Group aerobic exercise versus usual care in people with low back pain without sciatica | ||
Quality of life (SF-36 mental or physical component) <4 months | Favors intervention | Very Low |
Quality of life (SF-36 physical functioning or physical role limitation) <4 months | No statistically significant difference | Very Low |
Pain (VAS or McGill Questionnaire) <4 months | No statistically significant difference | Very Low |
Pain (VAS) >4 months | No statistically significant difference | Low |
Function (ODI) <4 months | Favors intervention | Very Low |
Function (ODI) >4 months | No statistically significant difference | Very Low |
Psychological distress (Radloff's Center for Epidemiologic Studies Depression Scale) <4 months | No statistically significant difference | Very Low |
Group mind-body exercise versus usual care in people with low back pain without sciatica | ||
Pain (VAS) at both <4 months and >4 months | Favors intervention | Very Low |
Group mixed exercise versus usual care in people with low back pain without sciatica | ||
Quality of life (SF-36) at <4 months | No statistically significant difference | Low to Very Low ᶜ |
Pain (VAS) <4 months | Favors intervention | Low |
Pain (VAS, change scores) <4 months | No statistically significant difference | Very Low |
Function (ODI/Roland Morris Disability Questionnaire, change score) <4 months | Favors intervention | Very Low |
Psychologic distress (Hospital Anxiety and Depression Scale) <4 month | No statistically significant difference | Very Low |
Recommendations as stated in the source guideline The National Institute for Health and Care Excellence (NICE) guideline on Low back pain and sciatica in over 16s makes the following recommendation: Consider a group exercise program (biomechanical, aerobic, mind–body, or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences, and capabilities into account when choosing the type of exercise.
Note NICE looked at evidence for both acute/subacute and chronic pain. This table has been added to both sections in the Best Practice topic. ᵃ The guideline also considered individual exercise programs, but as the evidence better supported group exercise (and this was the recommendation made), only the evidence for group programs has been included in this table. ᵇ Usual care as defined by individual included studies. NICE also considered evidence for the following comparisons: placebo, sham, attention control, waiting list, any other noninvasive intervention for nonspecific low back pain, different exercise programs versus each other, and combination therapy (with exercise therapy as the adjunct). See the guideline for more information. ᶜ GRADE rating is very low for all quality-of-life (SF-36) scores as listed in the guideline for this comparison group except for emotional role limitation, which is low.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of topical NSAIDS in adults with acute musculoskeletal pain?
- What are the effects of paracetamol in people with acute low back pain?
- In people with chronic low-back pain, is there randomized controlled trial evidence to support the use of therapeutic ultrasound?
- What are the risks and benefits of massage for low-back pain?
- What are the benefits and harms of multidisciplinary biopsychosocial rehabilitation in people with chronic low back pain?
- For adults with chronic pain, what are the benefits and harms of antidepressants?
- What are the effects of opioids compared with placebo or other treatments in people with chronic low-back pain?
Use of this content is subject to our disclaimer